Management of the long term psychological effects of rape among women survivors of the 1994 genocide in Rwanda : a grounded theory approach.

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Abstract

In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi
women. This study explored the long term psychological effects of rape experienced by these
women in order to develop a middle range theory to guide the management of the lasting
psychological effects of rape in the context of genocide.
A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin,
1990) was used. Data collection entailed in-depth interviews of twenty nine participants,
twelve of whom were rape survivors, ten were women who had not been raped, and seven
were men from their community. Open coding, axial coding and selective coding were used
to analyse the data.
The results have shown that women were negatively affected, physically, psychologically and
socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these
outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness,
somatic distress, negative self-image, altered intimate relationships and social isolation. The
extreme brutality, the humiliation that accompanied the experience of rape and multiple
losses were reported as risk factors for the lasting psychological effects of rape. These
negative outcomes were maintained by poverty, poor physical health, the burden of raising
the children born of rape, hostility and stigma from their community, and lack of appropriate
support and effective health care services. Facilitating the management of Genocide Rape
Trauma emerged as the core category of the middle range developed theory. Recovery from
Genocide Rape Trauma required formal and informal support, including psychological and
medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic
empowerment was a key element, while educating the community contributed to the social
integration of rape survivors and their children born of rape into their community. Women
had developed coping mechanisms of their own to attain psychological relief, and had
organized themselves into support groups. This study contributed to clinical practice by
providing a holistic approach to taking care of rape survivors. The inclusion of such theory in
the curriculum of health care professionals should contribute to the understanding of the
lasting impact of rape and how to handle it in an efficient manner.
Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of
the long term psychological effects of rape and Grounded theory.

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